Perforated oesophagus: review of twenty-eight consecutive cases

Oesophageal perforation is a potentially lethal condition which requires early diagnosis and prompt surgical management. The radiological features in 28 patients with oesophageal perforation have been reviewed and correlated with the aetiology and site of perforation, underlying oesophageal abnormality and the time interval between occurrence and diagnosis. Twenty-five patients (89%) had detectable abnormalities on the chest radiograph. The commonest abnormalities were air in the cervical or mediastinal soft tissues and air or fluid in the pleural cavity. The factors influencing the different radiographic signs are discussed. Studies with a suitable contrast medium are necessary to show the site and extent of the perforation, the extent of any associated abscess cavity and the position of the perforation relative to any primary oesophageal disease. Of 26 patients who had a barium swallow a leak was demonstrated in 21 (81%). In the five patients in whom no leak was demonstrated the examination was performed more than 24 h after the perforation.